Current status of regional citrate anticoagulation application in renal replacement therapy for critically ill patients
10.3760/cma.j.cn114015-20231108-00788
- VernacularTitle:局部枸橼酸抗凝在重症患者肾脏替代治疗中的使用现状
- Author:
Tingting WANG
1
;
Li JIANG
1
;
Meiping WANG
1
Author Information
1. 首都医科大学宣武医院重症医学科，北京 100053
- Publication Type:Journal Article
- Keywords:
Intensive care units;
Anticoagulants;
Renal replacement therapy;
Regional citrate anticoagulation
- From:
Adverse Drug Reactions Journal
2024;26(2):76-81
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To understand the current status of regional citrate anticoagulation (RCA) application in patients of Intensive Care Units (ICUs) and physicians′ thoughts on RCA.Methods:This study was designed as a status quo survey. Researchers independently designed a questionnaire (3 parts, 20 questions in total) and gathered data from 3 aspects, including general information of respondents, their thoughts of RCA, and the specific processes of RCA implementation in their ICUs. The survey was conducted online, and clinicians in ICUs across the country voluntarily participated from April 15 to April 30, 2022. Descriptive statistical analysis was performed to analyze the collected data.Results:A total of 630 electronic questionnaires were collected, of which 616 were confirmed as valid (an effective rate of 97.8%). These 616 physicians came from 587 ICUs in 21 provinces, 4 municipalities, 4 autonomous regions, and 1 special administrative region across the country. Among them, 530 were from hospitals of 3A-level, and 302 held senior professional titles. RCA was implemented in 488 (83.1%, 488/587) ICUs (involving 503 physicians), and no significant correlation was found between the type of ICU (general, internal medicine, surgical, or specialized) and whether RCA was conducted or not. The main reasons for RCA implementation in ICUs included having lower risk of bleeding (96.4%, 485/503), convenient monitoring (62.2%, 313/503), and guideline recommendations (62.0%, 312/503). RCA was not implemented in 99 (16.9%, 99/587) ICUs (involving 113 physicians), and the main reasons for not carrying out RCA were the absence of citrate sodium in hospitals (58.4%, 66/113), followed by lack of experience or protocols and higher cost (each 14.2%, 16/113). Among the 503 physicians in ICUs implementing RCA, 443 physicians (88.1%) believed that severe liver dysfunction (Child grade B and above) was a contraindication for RCA; 388 physicians (77.1%) and 377 physicians (75.0%) recognized metabolic alkalosis and hypocalcemia as complications of RCA, respectively; 273 physicians regularly monitored the total calcium/ionized calcium ratio daily; 276 physicians (54.9%) and 181 physicians (36.1%) set the blood flow rate at 120-150 ml per minute and 151-180 ml per minute, respectively; 377 physicians (74.9%) chose prepackaged replacement fluids, with pre-dilution+post-dilution as the dilution method (252 physicians, 50.1%); 239 physicians (47.6%) added sodium bicarbonate injection via a separate intravenous route; 400 physicians (79.5%) used a citrate sodium dosage plan of 1.2-1.5 times the blood flow rate per minute per hour.Conclusions:Currently, RCA is widely implemented in comprehensive ICUs in China, and relevant clinical physicians have certain knowledge of its contraindications and potential complications. However, different hospitals use varied protocols in implementing RCA, and a unified standard of monitoring method have not yet formed.
